Cardiopulmonary Considerations
What is the optimal timeframe for recovery ensuring that the frequency and duration prescribed are appropriate for an older adult client?
Between 30 min to 3 hours
Explain the difference between cachexia and malnutrition.
Cachexia- extreme weight loss. loss of mm without loss of fat mass. cannot be reversed through supplemental nutrition intake. associated with severe chronic diseases.
Malnutrition- low BMI or involuntary weight loss (seen externally) vs. micronutrient deficiencies
The Pain Assessment in Advanced Dementia (PAINAD) is scored from 0-10 with _____ scores indicating more severe pain.
higher
OA often have labs drawn. If an OA is found to have low platelets, this can lead to spontaneous bleeding. What is the medical term for low platelets?
Thrombocytopenia
An individual who is bed or chair bound, needs maximum assistance for self care/mobility, may vocalize pleasure/stress, and responds to stimuli inconsistently is at what level across the dementia spectrum?
Name 2 age-related (typical) cardiovascular changes that directly impact an older adult's orthostatic intolerance.
1. Reduced baroreceptor sensitivity
2. Poor vascular elasticity
3. Decreased blood volume
Describe the signs of mild dehydration (3/5)
dry mounth/tongue
light headedness/dizziness
weakness
headache
lethargy
Select the false statement related to the experience of pain in older adults:
A. OA experience more sites and longer duration of pain than younger adults.
B. Persistent pain is more common.
C. Recognition of pain is usually sudden and abrupt due to preservation of A-delta fibers.
D. OA have severely lessened ability to adapt to physical, emotional and environmental stressors.
C
Define "prescribing cascade" and give an example.
Providers prescribing medications to treat the side effects of other medications repeatedly.
Medicare provides coverage for which 4 groups of individuals?
1. 65+
2. Individuals with disability
3. Individuals with ESRD
4. Individuals with ALS
Older adults present atypically compared to younger counterparts when combating illness. Describe the signs/symptoms of either pneumonia or an MI in an older adult client.
Pneumonia: AMS and tachypnea (less commonly showing textbook signs of infection like fever or productive cough)
MI: sudden onset dyspnea, AMS, syncope
Name 3 factors that contribute to nutritional deficiency in older adults.
Disease of gums and teeth
Difficulty chewing or swallowing nutritionally dense foods
Postural changes, such as forward head, resulting in temporomandibular joint (TMJ) dysfunction
Changes in taste/smell
Loss of interest
Changes in social support
Lack of mobility
GI dysfunction
Name two recommendations to improve sleep among older adults.
2. Be aware of timing of caffeine consumption
3. Minimize alcohol intake
4. Limit screen time
5. Increase physical activity
6. Eat small meals in the evening
7. Meditation
Describe half life and therapeutic index. What are the ideal parameters for a medication to be safest?
TI = ratio of largest dose with no toxic Sx to smallest effective dose. Higher = safer.
HL = time it takes half of substance to be eliminated naturally. Shorter = leaves body quickest.
Describe the difference between terminal illness and terminal disease. What role can PTs fill for individuals seeking palliative or hospice care due to TI or TD?
Terminal illness prognosis = 3-12 mo
Terminal disease = prognosis much shorter
Dr. G will confirm accuracy of PT's role.
Explain the CURB-65 and how it is utilized.
C-confusion
U-uremia
R-respiratory rate >30 breaths/min
B-blood pressure SBP <90 or DBP<60
Age > 65
> 2pts = reasonable referral to hospital
Describe the clinical presentation associated with protein deficiency (3)
edema, enlarged liver, and muscle wasting
Decreased ability to protect against injury or infection
Skin regrows and heals at slower rate
Slowed inflammatory response
Decreased sensation
Decreased temperature regulation
Increased fragility
Pharmacokinetics includes 4 acts of what the body does to the drug. Name those 4 actions.
Absorption, distribution, metabolism, and excretion.
1. purpose
2. alternative options
3. risks of treatment
4. likelihood of success vs. failure
Describe the type (mode), intensity (% of perceived max), duration (min/session), frequency (x/wk) and time course (how quickly will we see results?) for an older adult at HIGH estimated functional capacity.
Type: based on goals
Intensity: steady state 70-85% of perceived max intensity
Duration: 20-40 min per session
Frequency: 3-5x per week
Time course: 3-6 mo. with healthy, active OA, 4-8 weeks for sedentary OA
Explain the GLIM criteria and how it is used.
1. Weight loss (>5% in past 6 mo or >10% beyond 6 mo)
2. Low BMI (<20 kg/m2 if <70 yrs or <22 kg/m2 if > 70 yrs)
3. Reduced muscle mass via validated body composition measurement
AND
1. reduced food intake
2. any chronic GI condition
Name three factors that contribute to constipation in older adults.
1. Dietary intake
2. Medications
3. CNS dysfunction
4. Mechanical blockage
5. Metabolic imbalances
*Risk factors also include aging, females, dec in mobility, dec in fluid intake, low fiber diet, and low SES.
Name 4 medications on Beer's list.
Dr. G will check accuracy because there are so many to list!
Describe the characteristics associated with someone at level 5 of dementia.
Earliest signs of change
Running on routine
"Their way or the highway"
Very independent/seeking constant reassurance
Resents take over
Repeats stories
Logic problems